PBL extra LOs Flashcards
what does the “tropin” suffix indicate
it acts upon another endocrine gland
what are the driving regulations for group 1 (car) diabetics (4)
- must inform the DVLA if taking insulin
- If you have more than one severe hypo while awake (not driving) in 12 months you must stop driving and tell the DVLA -> licence will be revoked but can reapply in 3 months
- If you have even one severe hypo while driving, you must stop driving and tell the DVLA straight away;
- if severe hypo while asleep, NO need to inform DVLA
what are the driving regulations for group 2 (HGVT) diabetics (2)
- must inform DVLA if taking insulin
- if severe hypo at anytime, even while sleeping, must inform DVLA -> licence could be revoked
what are the 4 steps for if you have a hypo while driving
- pull over safely;
- switch off the engine;
- take fast acting carbs;
- don’t drive until 45 mins after your blood sugar levels are back to normal
when should blood glucose levels be checked when driving (2)
- must be checked 2hrs before driving
- if driving for long journeys then they must be checked every 2 hrs
what is the blood glucose level needed for driving
5.0mmol/L on finger prick - 5 to drive;
4.0mmol/L on flash glucose monitoring
does the DVLA need to be informed if taking temporary insulin (<3months)
no- as long as healthcare team are being seen and advice is taken
does the DVLA need to be informed if taking sulphonylureas
no - unless more than one severe hypos while awake have occurred in the last 12 months -> licence will be revoked
does the DVLA need to be informed if taking diabetes medication other than (sulphonylureas)
no
what organisms are commonly found in diabetic foot ulcers
S.aureus and Pseudomonas aeruginosa
what is the Mgx for an unwell (flu/pneumonia etc.) diabetic pt with high blood glucose levels
2-6 units of short or rapid acting insulin subcutaneously -> glucose is likely high just due to glucose being released to aid the body in helping fighting off the infection -> so need to just control symtpoms
DKA management
FIG PICK
F – Fluids – IV fluid resuscitation with normal saline (e.g., 1 litre in the first hour, followed by 1 litre every 2 hours)
I – Insulin – fixed rate insulin infusion (e.g., Actrapid at 0.1 units/kg/hour)
G – Glucose – closely monitor blood glucose and add a glucose infusion when it is less than 14 mmol/L
P – Potassium – add potassium to IV fluids and monitor closely (e.g., every hour initially)
I – Infection – treat underlying triggers such as infection
C – Chart fluid balance
K – Ketones – monitor blood ketones, pH and bicarbonate
4 complications that could occur during DKA treatment
- Hypoglycaemia (low blood sugar)
- Hypokalaemia (low potassium)
- Cerebral oedema, particularly in children
- Pulmonary oedema secondary to fluid overload or acute respiratory distress syndrome
biochem values for DKA resolution
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
what is the next step if the DKA resolution criteria has been met
if the pt is eating and drinking then switch to sub cut insulin
3 areas of the body that insulin acts on
- In muscle, insulin promotes the uptake of glucose from the bloodstream, facilitating its entry into cells, as well as helping make new proteins;
- In adipose tissue, insulin promotes the uptake of glucose from the bloodstream, facilitating its entry into cells. This helps to lower blood glucose levels;
- In the liver, insulin inhibits the production and release of glucose. It also promotes the storage of glucose in the form of glycogen;
what molecule can be used to give an idea of insulin levels in the blood
c-peptide
insulin pathway in the liver
- glycogenesis: insulin binding to TRK receptors -> activation of PIK3/AKT -> these help to polymerise glucose into glycogen
- glycolysis: glucose –(PIK3/AKT)–> ATP
what is the only endogenous anabolic steroid
insulin (glucosepolymerised to glycogen)
what kind of transporter is GLUT4
an insulin dependent glucose channel (becomes hyperactive in the presence of insulin)
insulin in the muscles pathway
- insulin binds to TRK receptors in muscle cells -> activates PIK3/AKT -> increased activity of GLUT4 receptors -> increased glucose into cells -> PIK3/AKT aid in ATP production from glucose
- protesynthesis: increased amino acid uptake through stimulated amino acid channels -> increase protein synthesis;
- glycogensis: glucose -> glycogen
6 functions of insulin in the muscle
- stimulates glucose uptake (GLUT 4)
- stimulates glycogenesis
- stimulates glycolysis (-> ATP release)
- stimulates amino acid uptake and protein synthesis
- inhibits glycogenolysis
- inhibits proteolysis
insulin action in the hypothalamus
stimulates satiety
3 actions of insulin in adipose tissue
- stimulates glucose uptake (GLUT4)
- stimualtes lipogenesis
- inhibits lipolysis
